本文選題：胃癌 + 圍手術期輸血�。� 參考：《上海交通大學》2015年碩士論文

【摘要】：目的胃癌是排名第四的常見癌癥和導致癌癥相關死亡的第二大主因。胃癌患者常因急性/慢性出血、腫瘤消耗等因素造成不同程度的貧血,而輸血是糾正貧血最主要的治療方式。長期以來腫瘤患者輸血,特別是圍手術期輸血一直存在爭議,多數(shù)學者認為可能影響預后,縮短患者生存期。目前有相關研究認為圍手術期輸血系影響胃癌預后的獨立危險因素,但也有持相反意見者。為此,本研究擬通過回顧性研究,分析圍手術期輸血對胃癌患者預后的影響以闡明兩者之聯(lián)系,從而給臨床胃癌患者的治療提供借鑒。方法入選2008-2009年間在上海交通大學醫(yī)學院附屬瑞金醫(yī)院胃癌專業(yè)組確診并接受手術治療的281位胃癌患者,收集并錄入臨床資料、治療結果,完成隨訪后進行回顧性分析。通過統(tǒng)計學方法分析圍手術期輸血對于胃癌患者預后的影響。結果完成隨訪病例281例,其中男性183例,女性98例,中位年齡60歲。五年生存率未輸血組72.7%,輸血組45.8%,兩組存在統(tǒng)計學差異,提示圍手術期輸血胃癌患者總體生存率差于未輸血患者。依據術后病理TNM分期分析I期(早期)患者五年生存率,未輸血組96.6%,輸血組93.8%,兩組無統(tǒng)計學差異;II期患者五年生存率未輸血組70.7%,輸血組58.8%,存在統(tǒng)計學差異;III期患者五年生存率未輸血組44.3%,輸血組26.0%,存在統(tǒng)計學差異。研究結果提示圍手術期輸血為II期、III期(進展期)胃癌預后獨立危險因素。依據輸血時段分為術前輸血組、術中輸血組和術后輸血組,統(tǒng)計各自五年生存率:分別是術前輸血組60%,術中輸血33.3%,術后輸血56.3%;三組中以術中輸血組預后最差,存在統(tǒng)計學上差異。根據輸血量不同進行分析提示輸血量與預后無明顯相關性。多因素分析提示TNM分期II期、III期、術前低蛋白、術前低血紅蛋白、腫瘤侵及漿膜(T4)、淋巴結轉移、腫瘤大小≥5cm,病理低分化類型為胃癌預后的獨立危險因素。結論本研究結果顯示,圍手術期輸血為影響進展期胃癌患者預后的獨立危險因素,而輸血量多寡未顯著影響預后。胃癌患者圍手術期輸血特別是術中輸血應慎重且盡可能避免。
[Abstract]:Objective gastric cancer is the fourth leading cause of cancer and cancer-related deaths. Patients with gastric cancer often suffer from various degrees of anemia due to acute / chronic hemorrhage and tumor consumption, and blood transfusion is the main treatment to correct anemia. For a long time, blood transfusion in tumor patients, especially in perioperative period, has been controversial. Most scholars think that it may affect the prognosis and shorten the survival time of patients. At present, some related studies suggest that perioperative blood transfusion is an independent risk factor for the prognosis of gastric cancer, but there are others who hold the opposite view. Therefore, this study aims to analyze the influence of perioperative blood transfusion on the prognosis of patients with gastric cancer by retrospective study, so as to elucidate the relationship between the two and provide reference for clinical treatment of gastric cancer patients. Methods 281 gastric cancer patients who were diagnosed and treated surgically in Ruijin Hospital affiliated to Shanghai Jiaotong University Medical College from 2008 to 2009 were collected and recorded the clinical data and the results were analyzed retrospectively after follow-up. The effect of perioperative blood transfusion on the prognosis of patients with gastric cancer was analyzed statistically. Results 281 cases were followed up, including 183 males and 98 females with a median age of 60 years. The 5-year survival rate was 72.7% in the non-transfusion group and 45.8% in the transfusion group. There was statistical difference between the two groups, which suggested that the overall survival rate of the patients with gastric cancer during perioperative period was worse than that of the patients without blood transfusion. The 5-year survival rate of stage I (early) patients was analyzed by TNM staging. There was no statistical difference in the 5-year survival rate between the two groups. The 5-year survival rate was 70.7 in the non-transfusion group and 58.8 in the transfusion group. There was statistical difference in the 5-year survival rate between the non-transfusion group and the non-transfusion group (44.3%, 26.0%), and there was statistical difference between the two groups. The results suggest that perioperative blood transfusion is an independent prognostic risk factor for stage II stage III (advanced) gastric cancer. According to the period of blood transfusion, the patients were divided into preoperative transfusion group, intraoperative transfusion group and postoperative transfusion group. The 5-year survival rates of each group were as follows: the preoperative transfusion group was 60, the intraoperative transfusion was 33.3, the postoperative blood transfusion was 56.3, the prognosis of the intraoperative transfusion group was the worst. There is a statistical difference. Analysis according to the volume of blood transfusion showed that there was no significant correlation between blood transfusion volume and prognosis. Multivariate analysis indicated that TNM stage II stage III, preoperative low protein, preoperative low hemoglobin, tumor invasion of serous membrane T4, lymph node metastasis, tumor size 鈮，

本文編號：2025191